Schleimer Lauren E, Liu Annie, Kalvin Hannah L, Barekzai Ahmad Bashir, Choubey Ankur P, Jung Joslyn, Haque Rubiya, Jarnagin William R, Balachandran Vinod P, Geevarghese Ruben, Marinelli Brett, Gonen Mithat, Drebin Jeffrey, Allen Peter J, D'Angelica Michael I, Wei Alice C, Zani Sabino, Kingham T Peter, Lidsky Michael E, Soares Kevin C
Hepatopancreatobiliary Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Department of Surgery, Duke University Medical Center, Durham, NC, USA.
Ann Surg Oncol. 2025 May;32(5):3488-3498. doi: 10.1245/s10434-025-16915-8. Epub 2025 Jan 28.
A growing number of centers offer hepatic artery infusion pump (HAIP) chemotherapy for advanced liver malignancies. While small series have demonstrated feasibility of robotic HAIP placement, comparison of outcomes with open placement is lacking. We compared outcomes after robotic versus open HAIP placement.
We retrospectively reviewed HAIP placement without concurrent hepatectomy at Memorial Sloan Kettering Cancer Center from 1 January 2011 to 15 September 2022, and Duke Health from 1 November 2018 to 18 May 2023. Patients with prior liver surgery or who required catheterization of a non-standard vessel were excluded. Propensity score matching weights (PSMW) were calculated using age, sex, race, body mass index, American Society of Anesthesiologists class, neoadjuvant chemotherapy, colorectal procedure, and institution. Survey-weighted generalized linear models assessed the relationship between approach and outcomes.
Of 2002 consecutive HAIP placements, 819 (645 open/174 robotic) met the inclusion criteria. A higher proportion of open procedures involved combined colorectal procedures; other patient characteristics were similar. Overall, 15% of patients experienced an HAIP-specific complication and 12% required re-intervention; 2.7% had HAIP failure ≤ 90 days. After PSMW, the robotic approach had a longer operative time (β = 68 min, 95% confidence interval [CI] 55-81, p < 0.001) but shorter length of stay (β = - 1.8 days, 95% CI - 2.3 to 1.3, p < 0.001). The robotic approach was associated with increased HAIP-specific complications (odds ratio [OR] 1.72, p = 0.025) and re-intervention (OR 2.33, p < 0.001), with no difference in time to initiation of HAIP chemotherapy or HAIP failure.
Robotic HAIP placement was associated with increased postoperative complications and significantly shorter length of stay, with similar time to initiation of HAIP therapy. There was no difference in the rate of early HAIP failure versus the open approach. These results suggest robotic HAIP placement is feasible and effective.
越来越多的中心为晚期肝脏恶性肿瘤提供肝动脉灌注泵（HAIP）化疗。虽然小样本研究已证明机器人辅助放置HAIP是可行的，但缺乏与开放放置的结果比较。我们比较了机器人辅助与开放放置HAIP后的结果。
我们回顾性分析了2011年1月1日至2022年9月15日在纪念斯隆凯特琳癌症中心以及2018年11月1日至2023年5月18日在杜克健康中心进行的非同期肝切除术的HAIP放置情况。排除既往有肝脏手术史或需要对非标准血管进行插管的患者。使用年龄、性别、种族、体重指数、美国麻醉医师协会分级、新辅助化疗、结直肠手术及机构等因素计算倾向评分匹配权重（PSMW）。采用调查加权广义线性模型评估手术方式与结果之间的关系。
在连续2002例HAIP放置中，819例（645例开放手术/174例机器人辅助手术）符合纳入标准。开放手术中合并结直肠手术的比例更高；其他患者特征相似。总体而言，15%的患者发生了HAIP特异性并发症，12%的患者需要再次干预；2.7%的患者在90天内出现HAIP功能衰竭。经过PSMW分析后，机器人辅助手术的手术时间更长（β = 68分钟，95%置信区间[CI] 55 - 81，p < 0.001），但住院时间更短（β = -1.8天，95% CI -2.3至1.3，p < 0.001）。机器人辅助手术与HAIP特异性并发症增加（优势比[OR] 1.72，p = 0.025）和再次干预（OR 2.33，p < 0.001）相关，在开始HAIP化疗的时间或HAIP功能衰竭方面无差异。
机器人辅助放置HAIP与术后并发症增加及住院时间显著缩短相关，开始HAIP治疗的时间相似。早期HAIP功能衰竭率与开放手术方式无差异。这些结果表明机器人辅助放置HAIP是可行且有效的。
